Provider Demographics
NPI:1619930435
Name:KINGSBURY, MARTIN L (HEARING AID DISPENSE)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:L
Last Name:KINGSBURY
Suffix:
Gender:M
Credentials:HEARING AID DISPENSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3805 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-0547
Mailing Address - Country:US
Mailing Address - Phone:812-476-5577
Mailing Address - Fax:812-476-8580
Practice Address - Street 1:3805 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-0547
Practice Address - Country:US
Practice Address - Phone:812-476-5577
Practice Address - Fax:812-476-8580
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN17000995A237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist